Make rural service compulsory for medical students

It refers to the Prime Minister's warning to the government doctors who are diffident in taking up rural postings to quit their job. The acute shortage of doctors, nurses and technicians in rural hospitals has forced many patients to resort to traditional healers or, for those able to afford it, to seek medical care in the capital, overburdening the city's already crowded hospitals. It would be wise decision for the Ministry of Health and Family Welfare to make a three-year rural service compulsory for medical students. If students go to villages and express genuine interest in the welfare of the people, they will find that the villagers are extremely receptive to any idea to improve their health. Doctors can motivate the people to contribute towards improving the infrastructure and procuring equipment. There are good Samaritans in our countryside who donate for a cause. The alarming thing in Bangladesh is the almost total absence of primary care. Even in cities, there are no independent doctors' offices or neighbourhood clinics, so people have to go to the hospital for every health care need. Our rural people like security: we like the pope to be infallible in matters of faith, and grave doctors to be so in moral questions so that we can feel reassured. I envy children who know that they're going to become doctors, know they're going to go into the forces or whatever. I think choice is one of the hardest things, but that's what I try to give my only son, to say you can do anything. Quoting Dr Bob Bartlett, if parents take their children to doctors, they believe they are putting their faith in man instead of in God. If you believe the doctors, nothing is wholesome; if you believe the theologians, nothing is innocent; if you believe the military, nothing is safe. In all modesty, we must admit that governments are not always the best doctors when it comes to diagnosing economic ailments and prescribing the right treatment. My only son who has studied at a world famous university and a young writer by his own interest who contributes articles and opinions to our national media - has been sent back to Bangladesh to study medicine and surgery. I had a unique opportunity to meet with the well respected Principal and some faculty members of Dhaka Medical College during my one month long stay in Bangladesh last month. I just wanted to express my thanks and appreciation for the wonderful treatment and care they all showed to me and my son during the admission process and highly inspired to enter to learn and go to serve our poor nation. I became astonished to know from the Dhaka Medical College administration that a medical student's monthly tuition fee is only Tk 12 and hostel fee is only Tk 5.0. Moreover, each and every student receives scholarship every month from government's fund. How much subsidies are given from our government's exchequer for a student. Quoting Dr Donald Berwick, competition makes things come out right. Well, what does that mean in healthcare? More hospitals so they compete with each other. More doctors compete with each other. More pharmaceutical companies. We set up war. Wait a minute, let's talk about the patient. The patient doesn't need a war. Doctors are the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you, too. The greatest necessity, however, is that for a self-propelled, constantly supervised system of rural healthcare with a strong monitoring mechanism which will hold accountable doctors and staff for the number of patients examined and treated, cured and referred and the nature of treatment administered at these hospitals. But given the facilities in the primary health care centres in rural areas, a student is unlikely to do a good job. It is not certainly an ideal place for those at the beginning of their careers. The Ministry's rapid actions would help in improving health care in the rural areas. But it will surely add to the existing burden of the medicos in different hospitals and clinics in urban areas. It is time to take action now, or others will undergo a similar ordeal. I suggest that every hospital/primary health care centres in Bangladesh should have an ethics committee. The committee must include physicians, nurses and also someone non-medical from the community such as a local government representative, well respected volunteer. It should monitor the attending physician who has the ultimate authority to serve patients in rural areas. Hospice services should be available to patients and families in Bangladesh. My family and I are writing this to improve conditions in Bangladesh, a final gift from our mother to our motherland. In the name of Hypocrites, doctors have invented the most exquisite form of torture ever known to man: survival. The writer can be reached at e-mail : gopalsengupta@aol.com